The savvy tech strategy behind Obamacare

The ONC's Doug Fridsma explains why the health IT for EHRs and Obamacare should be like the Internet, and not like ERP or traditional IT systems

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Patient engagement: Are portals too separate and locked down to gain usage?

InfoWorld: That's fair enough. Let me ask you a little bit about the patient engagement part, because there's a data exchange with the patients. I'm a Kaiser Permanente patient, so I'm probably working with one of the more advanced versions of that. But one thing I've noticed in most implementations is that they are essentially locked environments. If a patient has multiple providers -- for example, my dental and optical providers are not the same as my medical -- and assuming all providers have some sort of patient portals, they don't really federate. It's not really a portal; it's three portals.

There also seems to be a notion that the information has to stay locked, even when given to the patient. It's not that easy to bring information into something else. I know Blue Button is an effort that seems to be pushing toward that. But it strikes me that we have a bunch of proprietary silos being built on the patient side similar to what we have on the provider side. Am I overreacting to what I see in the early days or is that a justifiable fear?

Fridsma: One of the things that I can say is that making sure that patients are not just the thing to which we deliver health care, but a full participant in health care, is going to be a really important part of our work going forward. If what happens is that we create a way for providers to talk among themselves that doesn't include the patients then we haven't really created that health care system, engaged the patients in their health care. A clear success criterion is to make sure the patients are engaged.

You mentioned the Blue Button activities, and that's a key part of what we need to accomplish. There is a challenge that you're going to have all these portals, and for you to be able to get an integrated view of your health care system, it's going to be really, really hard, because you have all these different places that you need to go.

I'll use an analogy from the financial sector. What we don't want is a whole series of portals into your investments and your bank and things like that. We want something that could eventually look like Mint.com, for example. We could integrate that and be able to take a look at all the things that are there.

There is a risk that we'll have these multiple portals, but I think it's probably an intermediate step to a better place. In the Blue Button, we've adopted the standard that's the same content standard, if you will, as what we have for providers. We've created a mechanism to allow that kind of exchange to occur. We're trying to, within Blue Button, expand the kinds of exchange protocols using both email and other ways, so we have the ability to have this integrate with some of the other EHR systems.

I think fundamentally it is really important for patients who see a doctor who uses one particular EHR that their data doesn't get locked into that EHR and can't go with them. If you were to leave Kaiser and move to a different provider that used a different EHR system, I think that we, as patients, have the right to get that information in computable ways so that we don't have a bunch of scanned images going forward that doesn't allow your new doctor to take advantage of clinical decisions, support, medication reconciliation, or some of the other things that might be possible.

You highlight an important point, one that I think we are working diligently to create ways that both the consumer and the provider, that information can be merged together. I think the Blue Button activities and the work of the Direct protocol is a first step in that. We still have more work that needs to be done. I think at the end of the day what will drive this is going to be patients who see the value of this, who demand that from their providers or from their health care systems.

And in fact there starts to be business drivers that make it advantageous to the organizations to share the information to include the patient in their health care and make sure that if you have multiple Web portals and the data isn't getting integrated in a way that you can perceive it, my guess is that same integration probably isn't happening at the provider side either.

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